SNMMI: Can 18F-Fluciclovine PET/CT Bolster Detection of PCa Recurrence in the Prostate Bed?

For the detection of PCa biochemical recurrence (BCR) in patients with negative PSMA PET/CT results, subsequent scanning with ¹⁸F-fluciclovine PET/CT may be advantageous, according to emerging research presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference.

For an ongoing prospective single-arm study, researchers assessed the use of ¹⁸F-fluciclovine PET/CT (Axumin, Blue Earth Diagnostics) obtained within a month after initial PSMA PET/CT scanning showed no definitive evidence of prostate cancer (PCa) recurrence in 46 patients with BCR and a prostate-specific antigen (PSA) level of at least 0.2 ng/mL. The study authors noted that patients did not receive anti-cancer treatment between the PET/CT scans.

Here one can see initial use of ¹⁸F-piflufostat PET/CT and axial fused PET/CT (A and B), which revealed an adrenal nodule with no PSMA uptake. Follow-up imaging with ¹⁸F-fluciclovine PET/CT and axial fused PET/CT (C and D) revealed abnormal uptake in the adrenal nodule, which was subsequently confirmed as metastatic prostate adenocarcinoma. (Images courtesy of SNMMI.)

The researchers found that ¹⁸F-fluciclovine PET/CT demonstrated positive findings in 54.3 percent of the cohort. Intended management questionnaires completed by treating physicians prior to and after the use of ¹⁸F-fluciclovine PET/CT showed that positive findings with the agent led to management changes for 85.7 percent of patients.

^“18F-fluciclovine PET detected disease in over half of the patients with BCR and negative PSMA PET. The ¹⁸F-fluciclovine PET, after a negative PSMA PET, lead to changes in the management of the majority of patients,” wrote lead study author Nadine Mallak, M.D., who is an associate professor of diagnostic radiology at the Oregon Health and Science University School of Medicine, and colleagues.

(Editor’s note: For additional research from the SNMMI conference, click here.)

The researchers pointed out that ¹⁸F-fluciclovine PET/CT detected regional nodal metastases in five patients and distant metastatic disease in eight patients. Conceding that PSMA PET/CT is more beneficial in identifying metastatic PCa recurrence, the study authors maintained that ¹⁸F-fluciclovine PET/CT may provide better detection of prostate bed recurrence. They noted that 12 of the 25 positive BCR cases (48 percent) detected with ¹⁸F-fluciclovine PET/CT involved local recurrence.

“While PSMA PET/CT is overall superior to ¹⁸F-fluciclovine (¹⁸F-FACBC) for the detection of nodal and distant metastatic disease, it may fail to detect disease in the prostate bed, potentially obscured by the urinary excretion of the most commonly used PSMA agents (⁶⁸Ga-PSMA-11 and ¹⁸F-piflufolastat), and PSMA-negative disease,” posited Mallak and colleagues.

(Editor’s note: For related content, see “SNMMI: What a New Meta-Analysis Reveals Abot Radiotracers for PET/CT Detection of PCa,” “SNMMI: Can Multimodal Monitoring Bolster Outcomes with Pluvicto in Treating mCRPC?” and “Key Takeaways: Head-to-Head Comparison of 18F-Fluciclovine and 68Ga-PSMA-11 in Prostate Cancer.”)

Reference

1. Mallak N, Obala G, Lim JY. Role of ¹⁸F-fluciclovine PET/CT in patients with biochemical recurrence of prostate cancer and a negative PSMA PET/CT. Presented at the Society for Nuclear Medicine and Molecular Imaging (SNMMI) conference, June 21-24, 2025, New Orleans. Available at https://www.xcdsystem.com/snmmi/program/B95p18u/index.cfm?pgid=2402&sid=46760 .